PROJECT SUMMARY This R03 award seeks to identify existing successful strategies to address childhood obesity in low socioeconomic status populations. A small proportion (10-15%) of children with obesity in early childhood achieve a healthy weight by adolescence. The goal of the overall project is to identify what behaviors these children and their families, termed positive deviants, have implemented that has been effective. By learning from what is already working among communities at high risk of continued obesity, interventions can be adapted to be more relevant and effective for families of children with obesity. The paucity of interventions shown to be effective for low socioeconomic status families and the increasing disparities in obesity for this population underscore the need to identify effective strategies. Aim 1 will use existing medical record data to examine weight trajectories from pre-adolescent, school aged children and categorize children into those who have a negative BMI slope towards a healthy weight (positive deviants) and children with a flat or increasing BMI slope (controls). Families are recruited to participate in a case-control study using mixed methods to define the skills and behaviors used to address their child's weight. In aim 2, we examine the biologic response to stress using cortisol, interleukin-6 and C-reactive protein, comparing positive deviants and controls to test the hypothesis that positive deviants, despite experiencing similar stressors, have a different biologic response to stress than controls. The completion of these aims will directly inform the design of an obesity-focused clinical trial testing the effectiveness of positive deviance- derived strategies paired with interventions designed to mitigate stress using biologic markers to personalize interventions. The project will occur in an exceptional research environment for using the resources of the Oregon Clinical and Translational Research Institute (OCTRI) to assist with data abstraction from a large medical record to generate the dataset. Dr. Foster (PI) has recently completed a similar project during his K23 award, with this project designed to build on the lessons learned during the K23 and strategically expand as a step towards an R01 application for testing the effectiveness of interventions designed using this approach.